Acute and Chronic Liver Diseases and Cirrhosis — WACS Viva & Clinical Scenarios (Gastroenterology and Hepatology)

Exam-style acute and chronic liver diseases and cirrhosis viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 38-year-old market trader presents with progressive abdominal distension, bilateral ankle swelling, and low-grade fever. Abdominal paracentesis yields cloudy fluid with an absolute neutrophil count of 380 cells/mm³. Laboratory evaluation reveals serum sodium 128 mmol/L, serum potassium 4.2 mmol/L, serum creatinine 168 µmol/L (baseline 80 µmol/L), total bilirubin 58 µmol/L, and international normalized ratio (INR) 1.8. Outline the diagnostic confirmation, immediate pharmacological management, volume expansion strategy, and criteria for determining hepatorenal syndrome-acute kidney injury (HRS
• SCENARIO 2: A 29-year-old woman is referred after routine antenatal screening reveals positive Hepatitis B surface antigen (HBsAg). Further testing demonstrates positive HBeAg, HBV DNA of 6.8 × 10⁷ IU/mL, and alanine aminotransferase (ALT) 28 IU/L. Discuss the clinical staging of her viral hepatitis, indications and timing for initiating antiviral therapy to prevent mother-to-child transmission, selection of agent, post-exposure prophylaxis for the neonate, and long-term maternal surveillance.
• SCENARIO 3: A 45-year-old commercial driver with known chronic alcohol misuse presents with jaundice, marked anorexia, tender hepatomegaly, and asterixis. Serum bilirubin is 220 µmol/L, aspartate aminotransferase (AST) is 240 IU/L, ALT is 95 IU/L, and prothrombin time is prolonged by 6.2 seconds compared to control. Explain how to stratify disease severity using validated prognostic scores, identify contraindications to systemic corticosteroid therapy, outline evidence-based second-line rescue regimens, and manage nutrition and encephalopathy in acute alcohol-associated hepatitis.
• SCENARIO 4: A 52-year-old man with decompensated cirrhosis secondary to chronic hepatitis B infection presents for planned large-volume paracentesis due to tense, diuretic-refractory ascites. Demonstrate the anatomical site selection, pre-procedural safety verification, aseptic technique, post-procedure plasma volume expansion protocol, and key preventive measures against paracentesis-induced circulatory dysfunction (PICD).
• SCENARIO 5: Critically discuss the surveillance, diagnostic imaging pathway, and staging-directed therapeutic management of Hepatocellular Carcinoma (HCC) in West Africa. Detail the target populations for biannual surveillance, the diagnostic utility of multiphase contrast-enhanced imaging versus biopsy, the application of the Barcelona Clinic Liver Cancer (BCLC) staging system, and the specific challenges of curative versus palliative management within resource-constrained healthcare environments.